Takele Habtamu, Alemayehu Mekuriaw, Geberu Demiss Mulatu
Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Eval Program Plann. 2023 Jun;98:102283. doi: 10.1016/j.evalprogplan.2023.102283. Epub 2023 Apr 7.
The government of Ethiopia revealed that GTP II and SDG were achieved through one Water Sanitation and Hygiene (WASH) program. According to the 2016 Ethiopian Demographic and Health survey, the rural population was more affected by poor sanitation and hygiene. To address this Ethiopian government ratified Rural WASH sanitation and hygiene promotion through a community-centered approach, and to improve WASH service evidence on the effectiveness of an intervention at the household level is needed in developing countries. However, in our country one WASH in rural areas called community centered approach intervention was planned and delivered for 3 years (2018-2020) Nevertheless, as to our review and researchers knowledge, the outcome of this intervention is not evaluated yet in our country as well as in this evaluation study area.
The evaluation was conducted in rural households of Jawi district by a Quasi-experimental design supplemented with a qualitative in-depth interview, from 01/14/2021-3/28/2021 and 4/22/2021-5/25/2021 for quanitative and qualitative study, respectively. Intervention groups were households that took WASH intervention while the controls did not. The evaluation approach was summative and counterfactual plus participatory and focuses on program outcome. A total of 1280 households were selected using two stage sampling with lottery method simple random sampling. We collected quantitative data through survey and structured observational checklist, while qualitative data through key informant interviews using a semi-structured questionnaire. We assessed program effectiveness and also the analytical study was conducted through propensity score matching to assess program effect through Stata 14.1. Qualitative data were transcribed and translated to English and thematic analysis was done using Atlas.ti.9.
The overall program effectiveness was very good but the effectiveness in handwashing before eating using soap and water was poor. Also, this intervention increased water treatment utilization in 41.7% point (ATT=0.417, 95% CI= 0.356, 0.478), 24.3% point (ATT =0.243, 95%CI=0.180, 0.300) in exclusive latrine utilization, 41.9% point (ATT=0.419, 95%CI = 0.376, 0.470) in handwashing using water and soap before eating, 50.2% point(ATT=0.502, 95%CI=0.450, 0.550) in handwashing after defecation by using water and soap in intervention households. Our qualitative finding revealed that unable to afford soap and their working place far away from their home were the most frequent reason reported by the respondent for not using soap for hand washing and latrine utilization respectively CONCLUSIONS: This intervention should be scale-up and pay greater attention and deliver innovative strategies to the improvement of handwashing practice and exclusive latrine utilization.
The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
埃塞俄比亚政府透露，第二个增长与转型计划（GTP II）和可持续发展目标（SDG）是通过一项水、环境卫生与个人卫生（WASH）计划实现的。根据2016年埃塞俄比亚人口与健康调查，农村人口受卫生条件差和个人卫生习惯不良的影响更大。为解决这一问题，埃塞俄比亚政府批准通过以社区为中心的方法促进农村地区的水、环境卫生与个人卫生，而在发展中国家，需要有关于家庭层面干预措施有效性的证据来改善水、环境卫生与个人卫生服务。然而，在我国，一项名为以社区为中心的方法干预的农村水、环境卫生与个人卫生计划已规划并实施了3年（2018 - 2020年）。然而，据我们的审查和研究人员所知，我国以及本评估研究地区尚未对该干预措施的结果进行评估。
评估于2021年1月14日至3月28日以及2021年4月22日至5月25日在贾维区的农村家庭中采用准实验设计并辅以定性深入访谈进行，分别用于定量和定性研究。干预组是接受水、环境卫生与个人卫生干预的家庭，而对照组未接受干预。评估方法是总结性的、反事实的以及参与性的，重点关注项目成果。采用抽签法简单随机抽样的两阶段抽样共选取了1280户家庭。我们通过调查和结构化观察清单收集定量数据，同时通过使用半结构化问卷的关键 informant 访谈收集定性数据。我们评估了项目有效性，并且还通过倾向得分匹配进行分析研究，以通过Stata 14.1评估项目效果。定性数据被转录并翻译成英文，并使用Atlas.ti.9进行主题分析。
总体项目有效性非常好，但使用肥皂和水在饭前洗手方面的有效性较差。此外，该干预措施使水处理利用率提高了41.7个百分点（平均处理效应（ATT）=0.417，95%置信区间（CI）= 0.356，0.478），独立厕所利用率提高了24.3个百分点（ATT =0.243，95%CI=0.180，0.300），在饭前使用水和肥皂洗手方面提高了41.9个百分点（ATT=0.419，95%CI = 0.376，0.470），在干预家庭中，排便后使用水和肥皂洗手提高了50.2个百分点（ATT=0.502，95%CI=0.450，0.550）。我们的定性研究结果表明，受访者报告买不起肥皂以及工作地点离家远分别是不使用肥皂洗手和使用独立厕所的最常见原因。结论：应扩大该干预措施的规模，并更加关注并提供创新策略以改善洗手习惯和独立厕所的使用情况。
在当前研究期间使用和/或分析的数据集可根据合理要求从相应作者处获得。
